MEDICARE: RAINE J ADAMS LAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	1394	MT

General Provider Information

NPI Number	:	1013342526
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAINE J ADAMS LAC

Provider Business Mailing Address
First Line	:	124 CUSTER ST
Second Line	:
City	:	WOLF POINT
State	:	MT
Zip	:	59201-1640
Country	:	US
Telephone Number	:	406-653-1872
Fax Number	:

Provider Business Practice Location Address
First Line	:	124 CUSTER ST
Second Line	:
City	:	WOLF POINT
State	:	MT
Zip	:	59201-1640
Country	:	US
Telephone Number	:	406-653-1872
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/04/2013
Last Update Date	:	09/04/2013

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